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Early pacemaker twiddler syndrome
1Pacemaker Department, Heart- and Lung Division, University Hospital of Lund, Lund, Sweden. thomas.fahraeus@skane.se
Summary
Twiddler's syndrome, a pacemaker complication, occurs when patients excessively rotate the pulse generator, leading to lead dislodgement and loss of pacing function. This case highlights rapid lead dislodgement due to generator manipulation shortly after implantation.
Area of Science:
- Cardiology
- Medical Devices
- Patient Safety
Background:
- Twiddler's syndrome is a recognized complication associated with pacemaker implantation.
- It involves patient manipulation of the pulse generator, leading to lead dislodgement and potential loss of capture.
- Previous descriptions detail lead dislodgement after significant generator rotation.
Observation:
- A patient presented with rapid development of exit block shortly after dual-chamber pacemaker implantation.
- The patient had manually rotated the pulse generator extensively within the pocket.
- The pacemaker leads were found to be tightly wound around the generator.
Findings:
- Exit block occurred within 17 hours of pulse generator implantation.
- The rapid manipulation of the dual-chamber pulse generator by the patient caused lead dislodgement.
- This resulted in a failure of the pacemaker to effectively stimulate the cardiac tissue.
Implications:
- Highlights the critical importance of patient education regarding pacemaker handling post-implantation.
- Emphasizes the need for vigilance in monitoring for early signs of Twiddler's syndrome, even within hours of implantation.
- Suggests potential for novel strategies to mitigate lead movement and prevent generator manipulation complications.